- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $16.22 / $43.65
| Facility | 26 | $8.91 | $16.22 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $41.69 / $104.71
| Professional | | $30.20 | $41.69 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.72 / $26.30
| Professional | 26 | $7.94 | $10.72 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $29.51 / $61.66
| Professional | TC | $21.88 | $29.51 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Facility | 26 | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $83.18
| Professional | | $32.36 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $13.80 / $24.55
| Professional | 26 | $10.23 | $13.80 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $31.62 / $61.66
| Professional | TC | $22.91 | $31.62 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.51 / $13.49 / $33.11
| Facility | 26 | $2.51 | $13.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $51.29 / $104.71
| Professional | | $31.62 | $51.29 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $14.79 / $28.84
| Professional | 26 | $8.71 | $14.79 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $38.02 / $81.28
| Professional | TC | $22.91 | $38.02 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $40.74 / $79.43
| Professional | | $30.90 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $11.75 / $22.39
| Professional | 26 | $8.91 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $29.51 / $56.23
| Professional | TC | $21.88 | $29.51 | $56.23 |